Abstract 17074: Primary Cardiac Sarcoma In Elderly Patient And Need For High Index Of Suspicion

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mohammad Ahmed ◽  
Carly Maucione ◽  
Nathaniel Long ◽  
Ryan Wilson
Keyword(s):  
Obstructive Coronary Artery Disease ◽  
Pulmonary Veins ◽  
Lesion Size ◽  
High Index ◽  
Surgical Removal ◽  
Cardiac Tumors ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
High Index Of Suspicion ◽  
Primary Cardiac Tumors

Case Presentation: Primary cardiac tumors are rare with an incidence between 0.0017 and 0.2%. Most cardiac tumors are benign such as myxomas, lipomas, and papillary fibroelastomas. Primary malignant cardiac tumors are even more uncommon, with cardiac sarcomas being the most common. We present a case of an 87-year old female who presented initially for progressive shortness of breath and concern for potential endocarditis vs intra-cardiac thrombus noted on outside hospital transthoracic echocardiogram. Blood cultures were negative, no leukocytosis or sequelae of infection were noted. Transesophageal echocardiogram (TEE) noted a large lesion attached to the anterior mitral leaflet, with additional lesions noted on the left atrial free wall just medial to the right sided pulmonary veins. Obstruction of mitral inflow was noted with a mean gradient through the mitral valve of 5mmHg. Cardiac MRI was performed for further delineation of lesions and based on tissue characteristics were felt to be thrombus (Figure 1). Hypercoagulability workup was negative, and there was no improvement in lesion size with systemic anticoagulation. Cardiothoracic surgery was consulted for surgical removal of the mass. Pre-operative cardiac catheterization showed multi-vessel obstructive coronary artery disease. It was also noted that the left circumflex artery appeared to supply blood into a discrete area in the left atrium. The patient was ultimately taken for surgical removal. Surgical pathology demonstrated primary high grade cardiac sarcoma. Discussion: The rarity and heterogeneity of primary cardiac tumors, along with many potential mimickers pose a diagnostic and therapeutic challenge. This, combined with the location and aggressive nature of the tumors, make them difficult to treat and incur a high mortality rate. This highlights the importance of maintaining a high index of suspicion and keeping a broad differential when evaluating intra-cardiac masses.

scholarly journals Left Circumflex Artery Rupture with Left Atrial Tamponade and Functional Mitral Stenosis

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Weiting Huang ◽  
Khaled Mohamed Emadeldin Moheb Hammad ◽  
Victor Tar Toong Chao ◽  
Khung Keong Yeo
Keyword(s):  
Left Atrium ◽  
Coronary Sinus ◽  
Mitral Stenosis ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Fluid Collection ◽  
Artery Dissection ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Coronary Syndrome

The growth in percutaneous transluminal devices has enabled operators to tackle more complex, native, and post-bypass surgery anatomy. However, complications such as coronary artery dissection, coronary perforation, retrograde aortic dissection, arrhythmias, and acute coronary syndrome still occur with resulting mortality rates of up to 4.2% in complex interventions. Perforation of the circumflex artery is of particular interest in view of its position and relation to the surrounding cardiac structures. This is a site of potential fluid collection, and as the left atrium is fixed to the parietal pericardium at the entry of the pulmonary veins, fluid in the oblique sinus can accumulate enough pressure to compress the left atrium and the coronary sinus. We present a case of left circumflex artery perforation which demonstrates the physiologic complications of coronary sinus and left atrial compression and the resultant functional mitral stenosis.

scholarly journals Left Atrial Myxoma with Tricuspid Regurgitation: Pathophysiology, Diagnostic Approach, and Management

2015 ◽  
pp. 28-3
Author(s):  
Prima Almazini ◽  
Bambang Budi Siswanto ◽  
Nani Hersunarti ◽  
Rarsari Soerarso ◽  
Amiliana M Soesanto
Keyword(s):  
Cardiac Myxoma ◽  
Clinical Manifestations ◽  
Definitive Treatment ◽  
Surgical Removal ◽  
Cardiac Tumors ◽  
Gold Standard Method ◽  
Left Atrial Myxoma ◽  
Associated Conditions ◽  
Cardiac Myxomas ◽  
Primary Cardiac Tumors

Cardiac myxomas are the most common primary cardiac tumors. Myxoma are more common in women. Clinical manifestations can mimic many cardiac and noncardiac conditions. Transthoracic echocardiography (TTE) is the gold standard method in the diagnosis of cardiac myxoma. The management of cardiac myxoma are medical therapy for the treatment of associated conditions and surgical removal as the definitive treatment.

scholarly journals Surgical resection of a giant cardiac hemangioma encroached upon the right coronary artery: A case report

2020 ◽  
Author(s):  
guangpu fan ◽  
Yu Chen
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Surgical Resection ◽  
Surgical Removal ◽  
Cardiac Tumors ◽  
Cardiac Hemangioma ◽  
Risk Of Rupture ◽  
The Right ◽  
Primary Cardiac Tumors

Cardiac hemangioma is relatively rare for primary cardiac tumors. The diagnose is mainly based on surgical resection and biopsy, imaging examinations only provide limited diagnostic clues. For those giant cardiac hemangiomas, which may raise a risk of rupture, need thoroughly surgical removal. However, meticulous follow-up is required due to its possibility of recurrence.

A Case of Primary Cardiac Rhabdomyosarcoma with Surgical Removal and Mitral Valve Repair

2013 ◽  
Vol 16 (3) ◽  
pp. 164 ◽  
Author(s):  
Mehmet Yilmaz ◽  
Tamer Kehlibar ◽  
Ismail Yucesin Arslan ◽  
Hale Yaka Yilmaz ◽  
Ibrahim Arif Tarhan ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Valve Repair ◽  
Clinical Presentation ◽  
Surgical Removal ◽  
Cardiac Tumors ◽  
Valve Repair ◽  
Primary Sarcoma ◽  
Cardiac Rhabdomyosarcoma ◽  
Echocardiographic Findings ◽  
Primary Cardiac Tumors

Primary cardiac tumors are rare. Nearly 25% of primary cardiac tumors are malignant, with rhabdomyosarcoma being the second most common primary sarcoma. Symptoms are variable, and the clinical presentation depends on the location and propagation of the tumor. Transthoracic and transesophageal echocardiography are preliminary tests in diagnosing the disease. Echocardiographic findings should be supported by other imaging methods. In appropriate cases, surgery combined with chemotherapy and radiotherapy is suggested. We present a case of primary cardiac rhabdomyosarcoma with surgical removal and mitral valve repair.

Prevalence and Localization of Hibernating Myocardium Among Patients with Left Ventricular Dysfunction

2019 ◽  
Vol 15 (9) ◽  
pp. 884-889
Author(s):  
Emine Acar ◽  
Ayşegül Aksu ◽  
Gökmen Akkaya ◽  
Gamze Çapa Kaya
Keyword(s):  
Scar Tissue ◽  
Left Ventricular ◽  
Hibernating Myocardium ◽  
Circumflex Artery ◽  
Irrigation Area ◽  
Left Circumflex Artery ◽  
Pet Ct ◽  
Perfusion Defects ◽  
The Right ◽  
Fdg Pet Ct

Objective: This study evaluated how much of the myocardium was hibernating in patients with left ventricle dysfunction and/or comorbidities who planned to undergo either surgical or interventional revascularization. Furthermore, this study also identified which irrigation areas of the coronary arteries presented more scar and hibernating tissue. Methods: At rest, Tc-99m MIBI SPECT and cardiac F-18 FDG PET/CT images collected between March 2009 and September 2016 from 65 patients (55 men, 10 women, mean age 64±12) were retrospectively analyzed in order to evaluate myocardial viability. The areas with perfusion defects that were considered metabolic were accepted as hibernating myocardium, whereas areas with perfusion defects that were considered non-metabolic were accepted as scar tissue. Results: Perfusion defects were observed in 26% of myocardium, on average 48% were associated with hibernation whereas other 52% were scar tissue. In the remaining Tc-99m MIBI images, perfusion defects were observed in the following areas in the left anterior descending artery (LAD; 31%), in the right coronary artery (RCA; 23%) and in the Left Circumflex Artery (LCx; 19%) irrigation areas. Hibernation areas were localized within the LAD (46%), LCx (54%), and RCA (64%) irrigation areas. Scar tissue was also localized within the LAD (54%), LCx (46%), and RCA (36%) irrigation areas. Conclusion: Perfusion defects are thought to be the result of half hibernating tissue and half scar tissue. The majority of perfusion defects was observed in the LAD irrigation area, whereas hibernation was most often observed in the RCA irrigation area. The scar tissue development was more common in the LAD irrigation zone.

Hypoplastic Left Circumflex Coronary Artery: Imaging Findings with Coronary Computed Tomography Angiography - A Case Report

2019 ◽  
Vol 15 (4) ◽  
pp. 427-429
Author(s):  
Asli Tanrivermis Sayit ◽  
Cetin Celenk
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Computed Tomography Angiography ◽  
Coronary Artery Imaging ◽  
Circumflex Coronary Artery ◽  
Circumflex Artery ◽  
Coronary Computed Tomography ◽  
True Incidence ◽  
Left Circumflex Artery ◽  
Artery Disease

<P>Background: Hypoplastic coronary artery disease is a rare congenital coronary artery anomaly. It is often detected incidentally, and its true incidence in the general population is not known. </P><P> Discussion: Symptoms of HCAD are syncope, palpitations, dyspnea, and chest pain. Also, arrhythmia and myocardial infarction can be seen; these can cause sudden death, especially in athletes and young people. Diagnosis is often made at autopsy. Conclusion: Here, we present the case of a 39-year-old male with isolated hypoplasia of the left circumflex artery detected by coronary Computed Tomography (CT) angiography who complained of palpitation.</P>

Neurobrucellosis associated with feral swine hunting in the southern United States

2020 ◽  
Vol 13 (12) ◽  
pp. e238216
Author(s):  
Harry Ross Powers ◽  
Jared R Nelson ◽  
Salvador Alvarez ◽  
Julio C Mendez
Keyword(s):  
United States ◽  
At Risk ◽  
High Index ◽  
Southern United States ◽  
Endemic Country ◽  
Feral Swine ◽  
Neurological Sequelae ◽  
Initial Symptoms ◽  
The Usa ◽  
High Index Of Suspicion

Although uncommon, Brucella infection can occur outside the areas of high endemicity, such as the USA. In the southern USA, hunters of wild swine are at risk for brucellosis. We present a case of a patient with fever, headache and constitutional symptoms that were ongoing for 11 months. He was diagnosed with neurobrucellosis. The patient was treated successfully with intravenous ceftriaxone, oral doxycycline and oral rifampin therapy. He had persistent neurological sequelae after completing treatment. This case illustrates the high index of suspicion needed to diagnose neurobrucellosis in a non-endemic country because initial symptoms can be subtle. The disease can be treated successfully, but long-lasting neurological sequelae are common.

scholarly journals Intracardiac EUS-B-Guided FNA for Diagnosing Cardiac Tumors

Respiration ◽  
2021 ◽  
pp. 1-5
Author(s):  
Haizea Alvarez Martinez ◽  
Jolanda C. Kuijvenhoven ◽  
Jouke T. Annema
Keyword(s):  
Left Atrium ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Needle Aspiration ◽  
Invasive Technique ◽  
Cardiac Tumors ◽  
Surgical Interventions ◽  
Tumor Diagnostics ◽  
Specific Tumor ◽  
Primary Cardiac Tumors

Primary cardiac tumors are extremely rare. Obtaining a tissue diagnosis is difficult and commonly requires open-heart surgery with associated morbidity. Esophageal endoscopic ultrasound (EUS) and EUS with the EBUS scope (EUS-B) provide real-time sampling of centrally located lung tumors and mediastinal lymph nodes. They also provide an excellent view of the left atrium, since it is located adjacent to the esophagus. To date, left atrium tumor diagnostics by endosonography is poorly explored. We describe 2 exceptional diagnostic cases of left atrium tumors in which cardiac surgery was hazardous due to the clinical condition or previous surgical interventions. During EUS-B-guided fine-needle aspiration (FNA), the left atrial masses were successfully and safely sampled, revealing a Burkitt lymphoma and a synovial sarcoma. FNA including cell block analysis enabled specific tumor diagnosis and molecular subtyping. Our findings suggest that in selected cases, linear endosonography qualifies as a minimally invasive technique for intracardiac tumor diagnostics.

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